But there is one aspect of pregnancy and birth that few people think about. For a small number of mothers, the joy of having a new baby is clouded by difficulties - usually temporary - of unwanted leakage from the bladder and occasionally from the bowel.
This advice will help you to minimise the chance of trouble. The risks are not very great, but there is no point in failing to take these simple steps to reduce them.
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During
your pregnancy
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Some women get a urine infection during pregnancy - you may get symptoms of discomfort or pain in passing water. If this happens to you, get prompt treatment for it: your doctor should prescribe antibiotics to rule out any risk of the infection taking hold. You can take precautions to avoid urine infections by good habits and hygiene:
After you have had a bowel motion, always wipe yourself from front to back, so that any bacteria are washed away from the urethra and vagina.
Do not delay passing water unnecessarily: it is normal to empty the baldder up to eight times in 24 hours, perhaps more often during pregnancy.
Do not restrict your fluid intake: during pregnancy and breast-feeding, you should drink more than usual - about 2 - 3 litres a day. (The usual figure is about 2 litres.)
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During
delivery
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Other
things being equal, a Caesarean section carries less risk than normal
obstetric childbirth to your later ability to control your bladder and
bowels. But a Caesarean section is an operation with risks of its own,
and so the increased (but still small) risk of bladder and bowel control
problems can only be one factor in your decision.
If you have had an epidural anaesthetic, it will take longer for sensation
to return in your bladder than elsewhere in your body, so that you may
not realise that your bladder is full. Often after the birth women are
fitted with a narrow tube (a catheter) to drain the bladder. If not, and
you leave it too long, your bladder may get stretched, with a risk that
you could do some permanent damage. The answer is simple: make sure you
try to empty your bladder two or three times during the first eight hours
after delivery even if you do not feel the need. If you are passing only
small amounts of water, ask the nurse or midwife for advice.
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Afterwards
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In the first weeks after your baby's birth you should avoid any pushing down movements that might strain and weaken these important muscles again. Here are some hints to help you protect them:
The only downward movement you should allow is when you are opening your bowels.
When you do open your bowels, hold a pad of toilet paper firmly against the area just in front of your back passage. This will stop your pelvic floor muscles from being over-stretched when you bear down. You may also find it helpful to lean forwards with your feet on a footstool.
If you are able, squeeze, lift and hold your pelvic floor muscles just before and during a sneeze or cough. This is called "the Knack". Try to do it also when you blow your nose or lift anything.
If you want to do any exercise or go to a gym, do not do high impact aerobics or lift heavy weights.
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Conclusion
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So do not suffer in silence: telephone the Continence Foundation Helpline and talk to a specialist nurse, talk to your GP or obstetrician or to your health visitor or the local specialist continence service - you can get their details from our Helpline.
Enjoy having your baby! There is no reason to fret or worry about the points in this leaflet: as we said, you will be bombarded with advice during your pregnancy and these points are just a few more to help you avoid trouble and get the best for your baby and the best for yourself.
If you want more information or to discuss the points in this leaflet, please ring our Helpline. It is open from 9.30 to 4.30 every weekday and is staffed by specialist nurses.
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Pelvic Floor Exercises
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Sit comfortably with your knees slightly apart. Now imagine that you are trying to stop yourself passing wind from the bowel. To do this you must squeeze the muscle around the back passage. Try squeezing and lifting that muscle as if you really do have wind. You should be able to feel the muscle move. Your buttocks and legs should not move at all. You should be aware of the skin around the back passage tightening and being pulled up and away from your chair. Really try to feel this squeezing and lifting.
Now imagine that you are sitting on the toilet passing urine. Picture yourself trying to stop the stream of urine. Try doing it now while you are reading this. You should be using the same group of muscles that you used before, but don't be surprised if you find this harder.
The Exercises
Now you can find your pelvic floor muscles, here is how to make and keep them strong:
2. These muscles also need to react quickly to sudden stresses from coughing, laughing or exercise that put pressure on the bladder. So practise some quick contractions, drawing in the pelvic floor and holding it for just one second before relaxing. Try to achieve a strong muscle tightening with up to ten quick contractions in succession.
Aim to do a set of slow contractions (exercise 1) followed by a set of quick contractions (exercise 2) six times each day.
Check You Are Doing the Exercises Properly
If you do not check, you may easily be tensing the wrong muscles! So check: if you place a finger in your vagina you should be able to feel the pelvic floor muscles squeeze, or you should be able to see the "lift and squeeze" effect in a small mirror.
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